PracticalDermatology

Keloid scarring has been considered to represent an abnormal wound healing response, but new evidence suggests a potential underlying immune pathogenesis of type 2 lymphocytes in keloid formation. This is why Emma Guttman, MD, PhD, Waldman Professor and System Chair, The Kimberly and Eric J. Waldman Department of Dermatology, Director, Center of Excellence in Eczema, Director, Laboratory of Inflammatory Skin Diseases at Icahn School of Medicine, is investigating the use of dupilumab, an agent that targets type 2 inflammation, for managing chronic keloids.

Darker-skinned and Asian individuals have higher rates of keloid development than Caucasians, with an incidence that ranges from 4.5% to 16% in this population. A family history of keloids increases the risk for the development of keloids. These thick, raised scars usually form on earlobes, shoulders, cheeks, or the chest.

A treatment plan for keloids may include:

• Injections of corticosteroids
• Surgery many times followed by radiation
• Silicone sheeting
• Cryosurgery
• Laser treatment
• Ligature

In addition to being aesthetically displeasing, keloids may also cause pain, itch, or burning.

Investigating a Novel Treatment

A novel study with weekly subcutaneous injections of dupilumab, an injectable drug marketed for eczema, is being conducted at the Department of Dermatology at Mount Sinai for patients with keloids. The new study has 24-week and 48-week endpoints, as it takes time to show changes in keloids due to their thickness. Results show improvement in a patient’s quality of life with decreased pain, itch, and physical appearance of keloids (See before and after photos above for some preliminary examples).

Dupilumab-treated patients reported highly notable improvement in symptoms, which may not be as evident in photos as are physical changes. Note that keloids are softer with reduced height, and patients whose keloids soften report far less itchiness and pain, leading to an improved quality of life.